Friday, February 11, 2011

A Look at the Family Smoking Prevention and Tobacco Control Act

The FSPTCA seems to directly contradict its purpose to improve the health of smokers. Not only does it perpetuate the myth that ALL tobacco is equally dangerous, it pushes the idea of dependency itself being inherently dangerous, whether or not the addictive chemical is actually a serious health risk.

Direct quotes from the FSPTCA:

A consensus exists within the scientific and medical communities that tobacco products are inherently dangerous and cause cancer, heart disease, and other serious adverse health effects.

Note that it says "tobacco products" and not "smoking," even though smokeless tobacco carries very little risk of cancer, heart disease and other SERIOUS health effects.

Nicotine is an addictive drug.

Yes, but it does not carry high health risks by itself. The word "addictive" is used in this sentence to say "bad" or "dangerous."

Tobacco use is the foremost preventable cause of premature death in America. It causes over 400,000 deaths in the United States each year, and approximately 8,600,000 Americans have chronic illnesses related to smoking.

Not including deaths questionably attributed to second-hand smoke, about 16.5% of all annual adult deaths in the U.S. are smokers/ex-smokers who died from smoking-related diseases (393,600 smoker deaths to 2,383,724 total U.S. adult deaths in 2007.) I cannot find data on smokers who died from non-smoking related diseases or natural causes. However, it's interesting to note that while 80-90% of lung cancer patients are smokers, only 10% of smokers actually get lung cancer. The 8,600,000 illnesses equals about 18.2% of smokers having a chronic illness related to smoking, which means 81.8% of smokers do not have smoking-related chronic diseases.

Not sure where I'm going with that one but it is interesting seeing it from a different persepective.

But it's important to note that they don't give actual statistics for smokeless tobacco and nicotine products. They are saying "tobacco" and then only give stats and health effects for "smoking," which intentionally leaves the reader thinking all tobacco use causes the same illnesses and diseases as smoking.

Tobacco dependence is a chronic disease, one that typically requires repeated interventions to achieve long-term or permanent abstinence.

Tobacco dependence ITSELF is a chronic disease?

Definition of disease: "a disordered or incorrectly functioning organ, part, structure, or system of the body resulting from the effect of genetic or developmental errors, infection, poisons, nutritional deficiency or imbalance, toxicity, or unfavorable environmental factors; illness; sickness; ailment."

Hmmm...didn't realize tobacco grew in my body.

SMOKING can CAUSE disease, but tobacco dependence is not a disease in and of itself. Dependence upon something not normally needed to keep the body healthy/alive would be a DISORDER: "a disturbance in physical or mental health or functions; malady or dysfunction."

Diabetics are dependent upon insulin, but insulin dependence is NOT a disease.

Exposure to radiation can cause disease, but taking risk and working at a job that exposes one to radioactive material is not a disease.

There may be underlying conditions which cause people to be more likely to become dependent upon nicotine/tobacco, but the dependency is not a disease. I suppose the same argument could be made for any chemical dependency.

Because the only known safe alternative to smoking is cessation, interventions should target all smokers to help them quit completely.

This sentence is nonsensical and redundant unless you deduct from it that "quit completely" means no tobacco or nicotine use, because isn't the definition of cessation "quit completely?" What this sentence really should say is "Because the only known safe alternative to smoking is to not smoke (cessation), interventions should target all smokers (not "tobacco users") to help them quit smoking completely. "

Well...DUH.

But what they are really saying is that they see no evidence that a smoker who switches to a smokeless alternative will reduce their health risks enough to justify encouraging them to switch and only complete abstinence from tobacco and nicotine is acceptable for them. It doesn't matter that repeated attempts at abstinence means repeated exposure to smoking, while the 1-2% risk from smokeless at least keeps them from smoking.

Well.....DUH again.

Again, they are expecting something to be 100% SAFE for treating tobacco dependence, when other disorders or diseases are usually treated with drugs that are SAFER. No medical treatment can be considered 100% SAFE, because they ALL have risk. This also lumps nicotine use in with smoking. Smokers aren't considered to have "quit completely" unless they quit any form of nicotine.

It is essential that the Food and Drug Administration review products sold or distributed for use to reduce risks or exposures associated with tobacco products and that it be empowered to review any advertising and labeling for such products. It is also essential that manufacturers, prior to marketing such products, be required to demonstrate that such products will meet a series of rigorous criteria, and will benefit the health of the population as a whole, taking into account both users of tobacco products and persons who do not currently use tobacco products.

Reduced harm products are seen as a possible threat - a ruse or fraud by tobacco companies. The criteria that it be considered safe for current non-smokers too makes it nearly impossible to get accepted. How can any tobacco product or even nicotine be considered acceptable for non-smokers to start using, even if it reduced risks to smokers by 99%?

Unless tobacco products that purport to reduce the risks to the public of tobacco use actually reduce such risks, those products can cause substantial harm to the public health to the extent that the individuals, who would otherwise not consume tobacco products or would consume such products less, use tobacco products purporting to reduce risk.

So, the product not only has to reduce risk for smokers, but has to ensure that people who would otherwise avoid nicotine products because of the perceived danger won't start using them because they now perceive them to be low-risk.

This is the theory that the non-tobacco users who will start using low-risk tobacco products will so outnumber the smokers who switch that MORE people have health risks. It completely ignores the level of risks and probability. Here is what it would take for that to happen:

1000 non-users start using 1% risk products = 10 people get sick

10 current users switch to 1% risk products = 9 people get healthier

So, in the above scenario, more people who otherwise wouldn't use tobacco products got sick than people who switched from smoking got better, resulting in an increase in health risks.

The problem is, there is no evidence or even reason to believe that so many non-users will suddenly use and so few users will fail to switch even when given the truth about reduced harm alternatives. But there is no way for a company to guarantee (however unlikely) that non-users won't be at greater risk to the point where it offsets the health benefits of users switching. It's an impossible criteria for approval.

One good thing in the Act which I think was completely unintended:

in order to ensure that consumers are better informed, to require tobacco product manufacturers to disclose research which has not previously been made available, as well as research generated in the future, relating to the health and dependency effects or safety of tobacco products;

Hmmm...so if the tobacco companies have research which supports the fact that smokeless tobacco is in fact safer than smoking, they can now not only say that but are REQUIRED to inform people? Awesome!

6 comments:

Insightful analysis, Kristin! It occurs to me that the authors of the FSPTCA might be more vested in the 8.6 Million smokers with chronic illnesses than the estimated 400k who drop out of the healthcare system each year. I wonder how much money those 8.6M are spending on treatments and pharmaceuticals to treat their chronic illness? "$96.7 billion is spent on public and private health care combined, according to the Campaign for Tobacco-Free Kids", but I think it would be more accurate to say that 'smoking-related diseases direct an additional $96B to public and private health care and pharmaceuticals.'

96 Billion reasons why healthcare and pharmaceutical companies secretly don't want smokers to switch to smoke-free alternative tobacco products. 96 Billion reasons why they would rather make tobacco and anything and anyone related to it the scapegoat.

For each 1000 smokers, 8 may die each year, but 187 have chronic diseases. If they switched to a 1% risk product, 185 fewer people might have chronic illness from smoking. If CTFK's numbers are to be believed, every 1000 smokers who switch to a 1% risk product would reduce health care spending by $2 Million. It's no wonder pharmaceutical NRT's are so expensive--on the slim chance it actually works, they have to make up the lost revenue!

All very true Kristin, and you've very clearly outlined the mindset of those who opposed Gio Gori (past head of the National Cancer Institute) et al who worked back in the 70s to create safer cigarettes. The rationale for the opposition of course was that "safer" cigarettes might interfere with efforts to eliminate smoking altogether, so the tobacco harm reduction type folks were simply slammed as being "Big Tobacco Puppets" and their careers and reputations destroyed.

While I've been strongly annoyed over the years by the non-content posting ads from e-cig vendors (which add insult to injury when they harp on the idea of how "stinky" smoking is) I've always felt they were a fine idea for people who liked them. The antismoking fanatics who agitate against them through the FDA etc simply fall into two classes:

1) Those freaked out by anything that LOOKS like smoking because it overthrows their denormalization/dehumanization efforts

and

2) Those driven by the Big Pharma interests wanting to hold onto their 5,000% profits in marketing fraction-of-a-cent nicogums for 50 cents apiece.

Keep on vaping, just remember though... you're now in a little boat right next to the smokers while the battleships are taking potshots at us!

Thadvocate, I understand what you mean when you say, "If CTFK's numbers are to be believed, every 1000 smokers who switch to a 1% risk product would reduce health care spending by $2 Million." but talking about believing CTFK's numbers is like talking about believing Baghdad Bob's proclamations that Saddam had driven the US out of Iraq while CNN was showing our tanks driving into their center square on the split-screen. :>

For a true analysis of the "smoking costs and taxes" claim see my piece at:

and remember that smokers subsidize the health costs of nonsmokers even *more* these days since there have been massive state and federal tax increases ( e.g. the 2,000% tax increase on Roll Your Own documented at: http://pro-choicesmokingdoctor.blogspot.com/2009/07/obama-in-bare-faced-lie.html ) since that was written.

I don't think the BP companies are as concerned about "losing business" due to healthier people as they are about "losing business" to alternative forms of enjoying nicotine and the feeling of smoking to competitors such as e-cigs from China. It's their own fault though: if they hadn't let themselves be run by the antismoking crazies who get apoplectic fits from the simple sight of smoking they'd have come out with these products themselves and be making a fortune right now.

Somehow I don't feel deeply sorry for them -- maybe that's a character defect. Or maybe it's simply deserved.

Thanks, Michael. I've read your work on your web site recently and appreciate your insight. I've become accutely aware that we share the high seas in the same war and it takes a while for vapers to come to that same conclusion.

You may be interested in my post a recent thread on e-cigarette-forum:

"I think the main issue is that a lot of us - probably all of us who quit for health reasons - became vapers in the first place because of believing what we were told by the antis. Some of it has a basis in truth, but a lot of it is false or blown way out of proportion - just as they are about e-cigarettes. It's only once we discover the lies being told about e-cigarettes that we start to wonder what else we were lied to about.

To be fair, smoker's rights advocates could cut us a little slack I think - maybe think of us as they would any new advocates, because we are now more open to their message than we would have been only a few months ago. They have to let us learn to walk first and if they just ignore us or even push us down out of frustration, we'll never learn to run. And vapers MUST be open to listening to smoker's rights advocates, because they have been where we are going and could teach us a lot. To be a smoker's advocate in this political climate takes a lot of fortitude, which is probably one reason why e-cig advocates have tried to distance themselves from seeming to be smokING advocates."

About the Author

Kristin Noll-Marsh is vice president of the Consumer Advocates for Smoke-free Alternatives Association. CASAA is a non-profit organization that works to ensure the availability of reduced harm alternatives to smoking and to provide smokers and non-smokers alike with truthful information about such alternatives.

This blog is Kristin's personal views and opinions and does not represent the views or policies of CASAA.